Case Study on pneumonia

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I. INTRODUCTION A distinguishing feature of lower airway and pulmonary vessel disorders is the presence of dyspnea. Dyspnea (shortness of breath) is a subjective experience that results when air flow, oxygen exchange, or both are impaired. The sensation of uncomfortable breathing can be as distressing as pain and can lead to severe functional disability. The intensity and frequency of dyspnea as well as its association with specific activities must be assessed to develop realistic expectations of treatment outcomes. Because the experience of dyspnea is associated with much anxiety, nursing interventions to relieve this manifestations are essential to the care of clients with conditions of the lower airways and pulmonary vessels. Pneumonia (pneumonitis) is an inflammatory process in lung parenchyma usually associated with a marked increase in interstitial and alveolar fluid. Advances in antibiotic therapy have led to the perception that pneumonia is no longer a major health problem in the United States. Among all nosocomial infections (hospital acquired), pneumonia is the second most common, but has the highest mortality. Pneumonia can be divided into three groups, which guide management: community acquired, hospital or nursing home acquired (nosocomial), and pneumonia in an immunocompromised person. Complications of pneumonia include pleural effusion, septic shock, pericarditis, bacteremia, meningitis, delirium, atelectasis, and delayed resolution.

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II. GENERAL DATA: Name: Ms. M.A.C Address: Ilihan, Toledo City Gender: Female Status: Infant Date of Birth: August 28, 2009 Age: 5 months old Nationality: Filipino Religion: Roman Catholic Father’s Name: Mr. H.C Father’s Occupation: Laborer Mother’s Name: Mrs. M.C Mother’s Occupation: Housewife Chief Compliant: Cough and LBM Date of Admission: February 24, 2010 Time Admitted: 12:50 AM

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Room Number: BB Admitting Diagnosis: Pneumonia, AGE with no Dehydration Physician: Dr. Egbert Ian Echavez III. HISTORY OF PRESENT CONDITION / ILLNESS The patient’s mother claims that her baby experienced cough for three days. According to the patient’s mother her child also experienced four episodes of LBM for one day and two episodes of vomiting prior to admission. The patient’s mother also claims that the night prior to admission, her child cries after every cough and felt that her child is hot to touch, which she concluded that her child has fever. With this situation, she was alarmed and decided to go to the hospital for her child to be checked upon. IV. PAST HEALTH HISTORY The patient’s mother claims that this is the first time her child was admitted in the hospital due to a serious condition. She also mentioned that whenever her child experiences mild fever and colds, she buys over the counter medications and uses herbal plants to alleviate the patient’s condition. According to her, her child doesn’t have any known allergy to any kind of food or drug. V. NURSING REVIEW OF SYSTEMS Nutrition – Metabolic Pattern

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Before Admission: As stated by the patient’s mother, the patient has good appetite. She drinks breast milk as often as possible. The patient’s mother also claims that before admission, the patient is a healthy child. During Admission: The patient’s mother claims that her child became thin due to her present condition. The patient is still able to drink breast milk from her mother despite her condition. Elimination Pattern Before Admission: According to patient’s mother, her child defecates everyday. Stool is solid and cylindrical in form. The color of patient’s stool is brownish or yellowish. According to patient’s mother she changes her child’s diaper 2-3 times a day. During Admission: The patient’s mother claims that her child defecates watery ,yellowish to brownish color of stool. She changes her child’s diaper 3-4 times a day. Activity – Exercise Pattern Before Admission:

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According to patient’s mother, her child shows activeness while playing with her toys and as well as playing with her. During Admission: The patient’s mother claims that her child seemed weak and cries upon coughing. Sleep – Rest Pattern Before Admission: According to patient’s mother, her child most of the time sleeps at home and wakes up or cries whenever she wants to drink milk. During Admission: The patient cries and is not able to sleep properly because of present condition. Role Relationship Pattern Before Admission: The patient’s mother claims that her child is able to interact and play with people she is familiar with but cries whenever she sees someone unfamiliar to her. During Admission:

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The patient’s mother claims that her child is still able to interact and play with people she is familiar with and still cries whenever she sees someone unfamiliar to her. VI. FAMILY, PERSONAL, SOCIAL AND ENVIRONMENTAL HISTORY A. MEMBERS OF IMMEDIATE FAMILY POSITION NAME Mr. H.C

AGE 29

IN THE FAMILY Father

GENERAL EDUCATIONAL OCCUPATION ATTAINMENT Highschool

HEALTH

Laborer

STATUS Healthy

Housewife

Healthy

Graduate Mrs. M.C

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Mother

Highschool Graduate

B. PERSONAL AND SOCIAL HISTORY The patient is the only child of Mr. and Mrs. Castillano. Because she is the only child, is well loved by her parents as well as her grandparents. The patient also cries upon seeing an unfamiliar face approaching towards her. C. ENVIRONMENTAL HISTORY The patient’s mother said that their house is near the road where most vehicles pass by. She also said that their house is made of cement and wood which is enough for her family to live in. According to her, cockroaches and flies are present at their house.

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They also own some appliances like television, radio and electric fan. They have an electric and water connection. They live in a place where houses are near each other. D. HEREDO – FAMILIAL HISTORY The patient’s mother claimed that they have a family history of being hypertensive but does not have any allergy to any kind of food or drug. They do not have a family history of being asthmatic. On the patient’s father side, there is no known serious condition. Aside from that, they have no other history of having serious illnesses. VII. Physical Assessment: GENERAL APPEARANCE The patient was seen lying on bed, conscious, febrile, with her mother beside her, with ongoing IVF # 2 D5.3% Nacl infusing well @ 22- 24 micro gtts/min on right arm. With the following vital signs of: Temperature – 38.4 ºC Pulse rate – 168 bpm Respiratory rate – 64 cpm Skin The patient has brown skin. Skin is smooth and soft to touch when being palpated. No ecchymoses noted. There are no lesions and masses palpated. Skin is also warm to touch with good turgor.

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Hair Patient’s hair is fine, proportionately distributed on the head with no greasy scales on scalp noted. No presence of infestations noted. No tenderness upon palpation of scalp noted. Head The shape of the patient’s head is symmetrical without depressions or bulging of fontanel. The head is round in shape. No tenderness upon palpation noted. Face Able to smile and frown, face is symmetrical in contour, no masses palpated. Eyes Patient’s eyes are positioned symmetrically. Patient can see clearly and reacts on moving objects. Patient’s eyes are not sunken, sclera is clear and moist. Ears Top of the ear is in lined with the imaginary line drawn from the outer cantus. Both ears are symmetrical to each other. No presence of any drainage and tenderness noted upon assessment. Nose and Sinuses

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Nose is symmetrical to both sides. Nasal flaring noted. No tenderness of sinuses upon palpation. Nostrils are patent. Mouth and Throat Patient’s lips are intact and moist. Oral mucosa is moist and reddish in color. Absence of lesions noted. Neck Able to hold her neck erect and at midline. Able to move neck from side to side without difficulty. No swelling or masses noted. Trachea is symmetrical and in midline position. Pulsation is felt in carotid artery. Lymph nodes are non- palpable. Anterior Chest Patient experiences tachypnea with respiratory rate of 64 cpm. Chest rises upon inspiration and falls upon expiration. No tenderness lumps and nodules felt during palpation. Crackles heard upon auscultation. Posterior Chest Posterior chest is symmetrical. No nodules and tenderness felt upon palpation. Heart No pulsations, heave or retractions. No murmurs heard upon auscultation. Breast

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No tenderness, masses or nodules noted upon palpation. Abdomen Abdomen is round and slightly protuberant. No swelling and tenderness noted. Veins are not visible upon inspection. No abnormal sounds heard on abdomen upon auscultation. Female External Genitalia and Anus No lesions noted. No tenderness noted upon palpation. Anus is patent. Upper Extremities Fingers, hands and wrist are straight. Elbows are at the same height and symmetrical in appearance. Able to move arms and hands without pain. Capillary refill of 2 seconds. Able to grasp objects firmly. Lower Extremities Legs and thighs are slightly curved No lesions or edema noted. Able to move legs and feet without any pain. VIII. DEVELOPMENTAL DATA Traditionally, infancy is designated as the period of time from 1 month to 1 year of age. In these important months, an infant undergoes such rapid development that parents sometimes believe looks different and demonstrates new abilities each day. During this time, an infant triples birth weight and increases length by 50%. A baby’s

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senses sharpen and, with the process of attachment to caregivers, she forms a first social relationship. Because of the growth and learning potential that occurs, this first year is a crucial one. Without proper nutrition, a baby will not grow and physically thrive, and without proper stimulation and nurturing care by consistent caregivers, an infant may not develop a healthy interest in life or a feeling of security essential for future development.

Summary of Infant Growth and Development

Month

Motor Development

0-1

Largely reflex

Fine Motor

Socialization and

Development

Language

Play

Keeps hands fisted;

Enjoys watching

able to follow object

face of primary

to midline

caregiver, listening

2

3

Holds head up when Has social smile

Makes

prone

sounds;

Holds

head

chest

up

soothing sounds. cooing Enjoys bright-

differentiates cry and Follows objects past Laughs out loud when midline

prone

to

colored mobiles Spends

time

looking at hands or uses them as toy

during

the

month(hand 4

5

Grasp,

stepping,

regard) Needs space to

tonic neck reflexes

turn

are fading Turns front to back;

Handles

no longer has head

well

lag

when

upright;

rattles

pulled bears

partial weight on

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feet

when

held

upright

IX. A. ANATOMY AND PHYSIOLOGY OF THE SYSTEMS INVOLVED

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The Respiratory system consists of the external nose, the nasal cavity, the pharynx, the larynx, the trachea, the bronchi and the lungs. Although air frequently passes through the oral cavity, it is considered to be part of the digestive system instead of the respiratory system. The upper respiratory tract refers to the external nose, nasal cavity, pharynx, and associated structures; and the lower respiratory tract includes the larynx, trachea, bronchi, and lungs. Nose The nose consists of the external nose and the nasal cavity. The external nose is the visible structure that forms a prominent feature of the face. Most of the external nose is composed of hyaline cartilage, although the bridge of the external nose consists of bone. The bone and cartilage are covered by connective tissue and skin.

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The nasal cavity extends from the nares to the choane. The nares or nostrils, are the external openings of the nose and the choane are the openings into the pharynx. The nasal septum is a partition dividing the nasal cavity into left and right parts. A deviated nasal septum occurs when the septum bulges to one side or the other. The hard palate forms the floor of the nasal cavity, separating the nasal cavity from the oral cavity. Air can flow through the nasal cavity when the mouth is closed or when the oral cavity is full of food. Three prominent bony ridges called conchae are present on the lateral walls on each side of the nasal cavity. The conchae increase the surface of the nasal cavity. Paranasal sinuses are air-filled spaces within bone. The maxillary, frontal, ethmoidal and sphenoidal sinuses are named after the bones in which they are located. The paranasal sinuses open into the nasal cavity and are lined with a mucous membrane. They reduce the weight of the skull, produce mucus, and influence the quality of the voice by acting as resonating chambers. The nasolacrimal ducts, which carry tears from the eyes, also open into the nasal cavity. Sensory receptors for the sense of smell are found in the superior part of the nasal cavity. Air enters the nasal cavity through the nares. Just inside the nares the epithelial lining is composed of stratified squamous epithelium containing coarse hairs. The hairs trap some of the large particles of dust suspended in the air. The rest of the nasal cavity is lined with pseudostratified columnar epithelial cells containing cilia and many mucus-producing goblet cells. Mucus produced by the goblet cells also traps debris in the air. The cilia sweep the mucus posteriorly to the pharynx, where it is swallowed. As air flows through the nasal cavities, it is humidified by moisture from the mucous epithelium and is warmed by blood flowing through the superficial capillary networks underlying the mucous epithelium.

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Pharynx The pharynx is the common passageway of both respiratory and digestive systems. It receives air from the nasal cavity and air, food, and water from the mouth. Inferiorly, the pharynx leads to the rest of the respiratory system through the opening into the larynx and to the digestive system through the opening into the larynx and to the digestive system through the esophagus. The pharynx can be divided into three regions: the nasopharynx, the oropharynx, and the laryngopharynx. The nasopharynx is the superior part of the pharynx. It is located posterior to the choaneae and superior to the soft palate, which is an incomplete muscle and connective tissue partition separating the nasopharynx from the oropharynx. The uvula is the posterior extension of the soft palate. The soft palate forms the floor of the nasopharynx. The nasopharynx is lined with pseudostratified ciliated columnar epithelium that is continuous with the nasal cavity. The auditory tubes extend form the middle ears open into the nasopharynx. The posterior part of the nasopharynx contains the pharyngeal tonsil, which aids in defending the body against infection. The soft palate is elevated during swallowing, this movement results in the closure of the nasopharynx, which prevents food from passing from the oral cavity into the nasopharynx. The oropharynx extends from the uvula to the epiglottis, and the oral cavity opens into the oropharynx. Food and drink all passes in the oropharynx. The laryngopharynx passes posterior to the larynx and extends from the tip of the epiglottis to the esophagus.The larynx (plural larynges), colloquially known as the voicebox, is an organ in the neck of mammals involved in protection of the trachea and sound production. The

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larynx houses the vocal folds, and is situated just below where the tract of the pharynx splits into the trachea and the esophagus. Sound is generated in the larynx, and that is where pitch and volume are manipulated. The strength of expiration from the lungs also contributes to loudness.The trachea, or windpipe, is the bony tube that connects the nose and mouth to the lungs, and is an important part of the vertebrate respiratory system. When an individual breathes in, air flows into the lungs for respiration through the windpipe. Because of its primary function, any damage incurred to the trachea is potentially life-threatening.The bony skeletal trachea is comprised of cartilage and ligaments, and is located at the front of the neck. The trachea begins at the lower part of the larynx and continues to the lungs, where it branches into the right and left bronchi. It measures 3.9 to 4.7 inches (10-12 cm) in length, and .62 to .7 inches (16-18 mm) in diameter. The trachea is composed of 16 to 20 “c” shaped rings of cartilage connected by ligaments, with a ciliated-lined mucus membrane. It is this structure that helps push objects out of the airway should something become lodged. Larynx The larynx is the portion of the breathing, or respiratory, tract containing the vocal cords which produce vocal sound. It is located between the pharynx and the trachea. The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck. We use the larynx when we breathe, talk, or swallow. Its outer wall of cartilage forms the area of the front of the neck referred to as the "Adams apple". The vocal cords, two bands of muscle, form a "V" inside the larynx.

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Each time we inhale (breathe in), air goes into our nose or mouth, then through the larynx, down the trachea, and into our lungs. When we exhale (breathe out), the air goes the other way. When we breathe, the vocal cords are relaxed, and air moves through the space between them without making any sound. When we talk, the vocal cords tighten up and move closer together. Air from the lungs is forced between them and makes them vibrate, producing the sound of our voice. The tongue, lips, and teeth form this sound into words. The esophagus, a tube that carries food from the mouth to the stomach, is just behind the trachea and the larynx. The openings of the esophagus and the larynx are very close together in the throat. When we swallow, a flap called the epiglottis moves down over the larynx to keep food out of the windpipe. Trachea A tube-like portion of the breathing or "respiratory" tract that connects the "voice box" (larynx) with the bronchial parts of the lungs. Each time we inhale (breathe in), air goes into our nose or mouth, then through the larynx, down the trachea, and into our lungs. When we exhale (breathe out), the air goes out the other way. The esophagus, the tube that carries food from the mouth to the stomach, is just behind the trachea and the larynx. The openings of the esophagus and the larynx are very

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close together in the throat. When we swallow, a flap called the epiglottis moves down over the larynx to keep food out of the windpipe. The trachea is also called the windpipe, weasand (sometimes written wesand or wezand) or wesil. "Cut his weasand with thy knife." The Tempest, Shakespeare. Bronchi The trachea divides into left and right main (primary) bronchi. Each of which connects to a lung. The left main bronchus is more horizontal than the right main bronchus because of it is displaced by the heart. Foreign objects that enter the trachea usually lodge in the right main bronchus, because it is more vertical than the left main bronchus and threfore more in direct line with the trachea. The main bronchi extend from the trachea to the lungs. Like the trachea, the main bronchi are lined with pseudostratified ciliated columnar epithelium and are supported by C- shaped pieces of cartilage. The large air tubes leading from the trachea to the lungs that convey air to and from the lungs. The bronchi have cartilage as part of their supporting wall structure. The trachea divides to form the right and left main bronchi which, in turn, divide to form the lobar, segmental, and finally the subsegmental bronchi. Bronchi is the plural of bronchus from the Greek word bronchos, a conduit to the lungs. Lungs The lungs are the principal organs of respiration. Each lung is cone-shaped, with its base resting on the diaphragm and its apex extending superiorly to a point about 2.5

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cm above the clavicle. The right lung has three lobes called the superior, middle and inferior lobes. The left lung has two lobes called the superior and inferior lobes. The lobes of the lungs are separated by deep, prominent fissures on the surface of the lung. Each lobe is divided into bronchopulmonary segments separated from one another by connective tissue septa, but these separations are not visible as surface fissures. There are 9 bronchopulmonary segments in the left lung and 10 in the right lung. The main bronchi branch many times to form the tracheobronchial tree. Each main bronchus divides into lobar bronchi as they enter their respectibe lungs. The lobar (secondary) bronchi, two in the left and three in the right lung, conduct air to each lobe. The lobar bronchi in turn give rise to segmental (tertiary) bronchi, which extends to the bronchopulmonary segments of the lungs. The bronchi continue to branch many times, finally giving rise to bronchioles. The bronchioles also subdivide numerous times to give rise to terminal bronchioles, which then subdivide into respiratory bronchioles. Each respiratory bronchiole subdivides to form alveolar ducts, which are like long, branching hallways with many open doorways. The doorways open into alveoli which are small air sacs become so numerous that the alveolar duct wall is little more than a succession of alveoli. The alveolar ducts end as two or three alveolar sacs, which are chambers connected to two or more alveoli. There are about 300 million alveoli in the lungs. As the air passageways of the lungs becomes smaller, the structure of their walls changes. The amount of cartilage decreases and the amount of smooth muscle increases, until at the terminal bronchioles, the walls have a prominent smooth muscle layer, but no cartilage. Relaxation and contraction of the smooth muscle within the bronchi and bronchioles can change the diameter of the air passageways. For example, during exercise the diameter can increase, thus increasing the

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volume of air moved. During an asthma attack, however, contraction of the smooth muscle in the terminal bronchioles can result in greatly reduced air flow. In severe cases, air movement can be so restricted that death results. As the air passageways of the lungs become smaller, the lining of their walls also changes. The trachea and bronchi have pseudostratified ciliated columnar epithelium, the bronchioles have ciliated simple cuboidal epithelium. The ciliated epithelium of the air passageways functions as mucuscilia escalator, which traps debris in the air and removes it from the respiratory system. The respiratory membrane of the lungs is where gas exchange between the air and blood takes place. It is mainly of the alveoli and surrounding capillaries but there’s some contribution by the alveolar ducts and respiratory bronchioles it is very thin to facilitate the diffusion of gases. Pleural cavity

In human anatomy, the pleural cavity is the body cavity that surrounds the lungs. The pleura are a serous membrane which folds back upon itself to form a two-layered, membrane structure. The thin space between the two pleural layers is known as the pleural cavity; it normally contains a small amount of pleural fluid. The outer pleura (parietal pleura) is attached to the chest wall. The inner pleura (visceral pleura) covers the lungs and adjoining structures, viz. blood vessels, bronchi and nerves. The pleural cavity, with its associated pleurae, aids optimal functioning of the lungs during respiration. The pleural cavity also contains pleural fluid, which allows the pleurae to slide effortlessly against each other during ventilation. Surface tension of the

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pleural fluid also leads to close apposition of the lung surfaces with the chest wall. This physical relationship allows for optimal inflation of the alveoli during respiration. The pleural cavity transmits movements of the chest wall to the lungs, particularly during heavy breathing. This occurs because the closely opposed chest wall transmits pressures to the visceral pleural surface and hence to the lung itself. IX.

B.

CONCEPTUAL

FRAMEWORK

ON

THE

CONDITION

/

PATHOPHYSIOLOGY

Etiologic/ risk factors

Inflammation

Non infectious causes

Organisms penetrate airway mucosa Aspiration of food and water

WBC migrate

Causes exudates collect in/ around alveoli Alveolar walls thicken

Hypoxemia

Signs and symptoms

Pneumonia

Reduced gas exchange

Organisms Immune system unable to fight Such as fungi, viruses & bacteria

From environment and other people Fatigue Chills Fever Cough Chest pain Sputum Production Dyspnea Tachypnea Crackles in lungs

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IX. C. DISCUSSION ON THE CONDITION / PATHOPHYSIOLOGY Upper airway characteristics normally prevent potentially infectious particles from reaching the sterile lower respiratory tract. Pneumonia arises from normal flora present in patients whose resistance has been altered or from aspiration of flora present in the oropharynx; patients often have an acute or chronic underlying disease that impairs host defenses. Pneumonia may also result from blood borne organisms that enter the pulmonary circulation and are trapped in the pulmonary capillary bed. Pneumonia affects both ventilation and diffusion. An inflammatory reaction can occur in the alveoli, producing an exudate that interferes with the diffusion of oxygen and carbon dioxide. White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normally air-containing spaces. Areas of the lung are not adequately ventilated because of secretions and mucosal edema that cause partial occlusion of the bronchi or alveoli, with a resultant decrease in alveolar oxygen tension. Bronchospasm may also occur in patients with reactive airway disease. Because of hypoventilation, a ventilation-perfusion mismatch occurs in affected area of the lung. Venous blood entering the pulmonary circulation passes through the underventilated area and travels to the left side of the heart poorly oxygenated. The mixing of oxygenated and unoxygenated or poorly oxygenated blood eventually results in arterial hypoxemia. If a substantial portion of one or more lobes is involved, the disease is refers to as “lobar pneumonia”. The term “bronchopneumonia” is used to describe pneumonia that is distributed in patchy fashion, having originated in one or more localized areas within the bronchi and extending to the adjacent surrounding lung parenchyma. Bronchopneumonia is more common than lobar pneumonia.

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D. SYMPTOMATOLOGY •

fever

•

chills

•

cough

•

tachypnea

•

breathing with grunting or wheezing sounds

•

labored breathing that makes a child's rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath)

•

vomiting

•

chest pain

•

abdominal pain

•

decreased activity

•

poor feeding (in infants)

X. MEDICAL MANAGEMENT A. TREATMENT AND PROCEDURES  Chest X-Ray –PA -A chest X-ray is a test that uses a small amount of radiation to create an image of the structures within the chest, including the heart, lungs, blood vessels and bones. A chest X-ray may be used to help diagnose and plan treatment for various conditions, including lung disorders such as pneumonia.  Nebulization - To deliver medication by a fine mist that is inhaled directly into the lungs. Medication used is Salbutamol which dilates bronchioles of patients having bronchospasm.

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B. MEDICATIONS



Cefuroxime (Zinacef) – 180 g IVTT every 8 hrs.



Salbutamol (Ventolin)- 6 mc ½ nebule every 6 hrs.



Paracetamol (Calpol)- .8 ml every 4 hrs. for temperature >38ºC



Zinc Sulfate- 2ml OD



Protexin Balance- 1 cap BID mixed with 5ml H20

C.

DIAGNOSTIC PROCEDURES

 Complete Blood Count- An individual's white blood cell count can often give a hint as to the severity of the pneumonia and whether it is caused by bacteria or a virus. An increased number of neutrophils, one type of WBC, are seen in bacterial infections, whereas an increase in lymphocytes, another type of WBC, is seen in viral infections.  Urinalysis - The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is ordered widely and routinely to detect any abnormalities that require follow up.  Stool exam- To determine whether you have pathogenic bacteria in your gastrointestinal tract.

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Diagnostic exam Fecalysis Macroscopic

Result

Normal values

color yellow Cellular finding Hematology Hgb Hematocrit WBC WBC Differential Count Stab Segmenter Lymphocyte Monocyte Eosinophil Basophil Platelete

soft in consistency Fat globulesmoderate Bacteria – abundant 123g/L - .37 20.30 x 10 /L

120-160g/L 0.37-0.49 5-10x 10 /L

.14 .23 .63 0 0 0_ 1.0 307 x 10 /L

150-400 x 10 /L

D. DIET The patient is breastfed by mother which is her only source of nutrition. The patient is breastfed as often as necessary. XI. NURSING MANAGEMENT A. ACTUAL CARE GIVEN

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Care given to patient includes nebulization. Performed tepid sponge bath. Also instructed SO to give paracetamol to patient when pt’s temperature is above normal limits. Provided a clean environment for the patient to prevent exacerbation of patient condition. . Frequent breastfeeding and promoting fluid intake was very much encouraged because labored breathing may lead to insensible fluid loss that would lead to dehydration if not monitored. Vital signs taking was also monitored every 4 hours. I and O taken every shift. B. PROBLEMS ENCOUNTERED DURING THE IMPLEMENTATION OF NURSING CARE I haven’t encountered any problem in implementing nursing care to the patient because the patient’s mother was very cooperative. Even though the patient cries whenever I get her vital signs, her mother was always there to help me that is why I was able to manage taking care of the patient. C. RESTORATIVE MEASURES USED I was able to perform tepid sponge bath whenever the patient’s temperature is above normal limits. I also assisted in nebulization of patient which promotes bronchodilation. Thus, facilitates proper breathing. I also provided a clean and safe environment for the patient. D. EVALUATION I think, what I have done is partially effective because patient’s condition was slightly reduced to normal. Patient also has a certain time to rest to conserve energy.

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Activities were limited and asked to adhere on a complete bed rest all the time with the help of the significant others. Hydration is good as evidenced by an adequate fluid intake and urine output and with a normal skin turgor. Patient’s complies with all management strategies and also complies with treatment protocol and prevention strategies for her sake. E. PATIENT TEACHING Patient education is crucial regardless of the setting and the proper administration of antibiotics is important. In this case in which the patient is still 5 months old, she is still dependent on her parents especially her mother to care for her. In these instances, the patient is initially treated with intravenous antibiotics in the hospital or may be in home setting. It is important that a seamless system of care be maintained for the patient from hospital to home, this induces communication between the nurses caring for this patient in both settings. In addition, oral antibiotics are prescribed, the importance to teach the patient’s mother about proper administration and potential side effects was greatly taught. Patient’s mother was also advised to avoid exposing the patient to sudden changes in temperature that will further lower her immune system. Adequate nutrition was greatly emphasized to patient’s mother to boost the immune system. XII.A. CONCLUSION At first I was hesitant to approach the patient, but when I came to know her significant others, especially her mother, my anxiety decreased and was able to mingle with them accordingly. I never thought that family members of the patient would be that

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warm and cooperative to me. With this study I have, I learned a lot of things in life. Confidence in dealing with difficult situations, although encountered many times, will still bother you. Because of the fact that different situation have different results, you tend to be anxious of the outcome. As a student nurse, we should be flexible in dealing with situations so as to have a positive result. We should be responsible enough in any actions that we do. We can be successful by our own little way with guidance from God. A patient should always be treated well whatever the patient’s status might be. Perseverance and determination will help us to succeed. Serving the needs of the ill is the primary role of a nurse and that shall be enhanced as we go along our journey in life. B. RECOMMENDATION This case study promotes the growth and wellness of the patient and her parents, as well as the nurse. Current trends and issues should be examined and undergo specific observations to enlighten the minds of students in understanding an infant with pneumonia. This case study is focused more especially as to with health care providers, that would serve as a guideline on how to render effective nursing care to patients having pneumonia. This would be of great help on how to manage those infant patients with pneumonia who are physically not in a healthy state. XIII. IMPLICATIONS OF THE STUDY TO: A. NURSING EDUCATION Aspiration is a common problem that can lead to Severe Pulmonary complications, potential complications of aspiration include obstruction, inflammation

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and infection. Nursing assessment and knowledge of risk factors are key in evaluating patient at risk for potential aspiration problems and preventing this complication. The focus of this study is in the optimal health of the patient and to know the complications it may lead. As a student nurse, it is very important in our field that we both have knowledge and competent skills that we may apply in the near future. B. NURSING PRACTICE Nursing is the diagnosis and treatment of human responses to health and illness and therefore, focuses on a broad array of any phenomena. Knowledge, skills and ability should always come together. Knowledge alone is not enough neither skills nor ability is not enough. It is an important factor that we perform nursing actions considering its rationale and principles for it guides us in the care that we give to our patients. Skill needs to be mastered as we go through the journey of the field we choose to have. C. NURSING RESEARCH Nursing research is designed to help solve particular, existing problems so there is a much larger audience eager to support research that is likely to be profitable or solve problems of immediate concern. Much medical research on pneumonia with considerable impact is a good example. Some sort of research is required to support normal decisionmaking. Just as nursing is dynamically changing, so is with the nursing research. We should be updated in laboratory test and procedures that are constantly changing over time.

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